Provider Demographics
NPI:1962736199
Name:WHOLE CHILD THERAPEUTICS
Entity type:Organization
Organization Name:WHOLE CHILD THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:541-806-0047
Mailing Address - Street 1:788 FOXLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9722
Mailing Address - Country:US
Mailing Address - Phone:541-806-0047
Mailing Address - Fax:541-386-3868
Practice Address - Street 1:788 FOXLEY RD
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9722
Practice Address - Country:US
Practice Address - Phone:541-806-0047
Practice Address - Fax:541-386-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1021091225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty